Pneumonia is the old man’s friend. Passing along this wisdom from his cousin-the-doctor to my then 20-something self, my father is amused by my momentary startlement. But my slight shock at this saying yields almost instantly to delight at its pithiness: how something so short can say so much about the human condition, especially the leave-taking thereof. Early 20-ish that I am, death being a release isn’t something I think about much. Early 20-ish that I am, I don’t have much experience with death in any form, especially not the long, often painful good-bye.

Fast-forward 30 years and I am Googling causes of death for an incurable, progressive neurological disorder: multiple system atrophy. Seated beside me is an old man so afflicted: my father.

Akin to Parkinson’s, multiple system atrophy wreaks havoc with the body’s autonomic systems: those not under conscious control. Over time, fine motor skills deteriorate: say goodbye to dressing unaided. Facial muscles lock in unsightly but meaningless grimaces: say hello to small children eying you askance. The voice-box seizes at the moment of truth: say goodbye to the delights of repartee, even to the pleasures of easy conversation. Swallowing thin liquids becomes nigh impossible: say goodbye to that martini nightcap, that morning cup of coffee. Blood pressure swings from stroke range to passing-out range in a single day, even a single hour: say hello to a regimen of pills to manage the extremes, with four-times-daily status monitoring to direct the pill taking. But pills require swallowing: so say hello, too, to a bitter struggle to override muscles defying both unconscious and conscious control. Often excruciating to watch, how much worse is it to experience? Life with an incurable, progressive neurological disorder gets complicated in so many ways.

Today, however, the question is simple: How do people die of this condition? When he first asked, yesterday, I demurred. The night has brought a different perspective: would that Google were as malleable. But the problem lies not so much with the noble search engine as with the reluctance of doctors and researchers to talk about the end game, even for incurable, progressive neurological disorders. They speak plainly enough of average life expectancy from diagnosis: a figure my father has already blown by. They are unsentimental in quantifying the likelihood of ending in a wheelchair: a fate my father has thus far been spared. But they do not speak of the kind of death to be expected. We are well down the list of results before we find one that answers my father’s typically straightforward question with the unexpectedly simple: the most likely causes of death are heart failure and pneumonia. Never one to show his emotions, my father nevertheless seems satisfied with this conclusion to our search. The elderly view death with a matter-of-factness that the merely middle-aged lack.

For my part, I feel uncomplicated relief at dodging unspecified horrors. Independent of the multiple system atrophy, my father has a heart condition: surely a catastrophic heart attack is both probable and probably quick. As for pneumonia, it’s the old man’s friend, right? And there things stand for a few more years.

Our evening visit is an extra that day. After three weeks of backing-and-forthing to hospital we are all tired, but reluctant to leave my father alone for long in his new hospice digs. He greets my son and me with a shadow of his trademark dry wit, but his fever is back up. As the nurses come in, we go out so they can do what they can by administering comfort meds: anything that does not interfere with the inevitable. I walk down the hallway, weeping, my grief at my father’s inevitable death exacerbated by anger at the manner of it.

For 35 years I have held this notion in my head, that pneumonia means an easy death. Exactly what that entails I am not sure, but I am sure it is not the influenza-on-steroids that my father has been suffering these last few weeks. I am sure it should not be waves of overheating, or the delirium that accompanies the morphine given to bring down that fever. I am positive it should not sound like a gurgle with every breath, or feel like the achiness that is not relieved by lying down. Loving good-byes all round, and a slipping away in his sleep: these are more what I had in mind. On this evening of his first day in hospice, however, it does not matter what I or he or his cousin-the-doctor had in mind.

Back at bedside, we report the irrelevancies of our day to distract him until the meds can take hold. As they do, he seems to lapse into semi-consciousness, but we have learned the hard way that looking asleep does not mean being asleep, any more than seeming awake means being lucid, so we keep talking to him. None of this is out of the ‘new ordinary’—until he stops breathing.

We call the nurse, although part of me knows she cannot do anything: he has, after all, come here to die, although none of us had any thought it would be tonight. He takes another breath. He stops again. The junior nurse goes to get the senior nurse. Hand on his shoulder, I can feel his body warmth: Is this what death feels like? His face is peaceful: Is this what death looks like? Did he just breathe again? Yes. No. Maybe. I Can’t Tell. I stand there stupidly while my brain races in tighter and tighter circles.

Death in the movies is always so clear—maybe not easy, but clear. People are alive, and then they are dead. There is no wondering. Yet, at almost 60, I am as unprepared to be in the room with death as my 20-something self was to think about death as a release; as reluctant to acknowledge the fact of death as those doctors and researchers were to discuss its mechanics.

Neither unprepared nor reluctant to face death, the senior nurse arrives and pronounces. My turmoil is just beginning, but my father’s—finally—is done. Pneumonia is the old man’s friend.

10 Responses to The Old Man’s Friend

Another thoughtful essay. It brought tears to my eyes as I recalled Rob’s passing. Luckily Rob’s was much easier than your Dad’s, but we are never prepared, no matter how difficult the illness or how easy the end.
Thinking of you on this Father’s Day.

Yes, it was Joni Mitchell who said that best: Don’t it always seem to go, that you don’t know what you’ve got ’til it’s gone? I was amazed by my father’s stoicism in the face of physical ailments that would elicit, I’m sure, near-constant complaining from me.

As it was when I first read this, I cried, but it is somehow comforting too. He did so well through all that last struggle, as in the years before of declining health, and in the last minutes slipped away so peacefully. I miss him constantly, but am thankful that, for him, it is over. MMG

Isabel, it has taken me until a day of solitude to be able to bring myself to read this. I cry as I recall the difficulties dad faced and how it was impossible for us to provide anything meaningful in the way of support. Death doesn’t scare me, but dying I’m pretty leery of at this point. Lots of love and thanks for the tribute… to all of us really.

I remember a movie (of course!) about an American woman who married a Japanese diplomat just before WWII (oops) and went back to Japan with him and their daughter (Bridge to the Sun, I think). He died young-ish of cancer and instead of talking to her about it, sent her away with the now high-school-aged daughter. She figured out what was going on and wanted to stay — but didn’t talk to him about it. (Hmmm.) A friend of his told her to go so she could remember her husband in his strength, not his sickness. He said, Death may be be beautiful, dying is not. So to your point about being leery of dying – well, yes. (Although, like Mom’s essay on aging, there may be beauty if we know how to look for it.) As to not being able to provide meaningful ‘help’ – if you flip it and try to guess what his point of view on it might have been (hmm… what do Scots & Japanese have in common?) it seems to me that just being there through the whole thing was all we could do – and all he needed from us.

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